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TREASURY DEPARTMENT 
UNITED STATES PUBLIC HEALTH SERVICE 

RUPERT BLUE, Surgeon General 



THE 
HYGIENE OF RURAL SCHOOLS 



BY 



TALIAFERRO CLARK 

HI 

Surgeon, United States Public Health Service 



REPRINT No. 219 

FROM THE 

PUBLIC HEALTH REPORTS 

September 11, 1914 




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WASHINGTON 
GOVERNMENT PRINTING OFFICE 

1919 



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THE HYGIENE OF RURAL SCHOOLS.^ 

By Taliafbero Clark, Surgeon, United States Public Health Service. 

In connection with recent field investigations opportunity was 
presented to make observations of the sanitary condition of a large 
number of rural schools, over an extended area. 

The main object of these investigations, however, was to determine 
the prevalence of certain diseases, especially trachoma. Owing to 
the necessity for rapid inspections, in order to complete the work 
within a reasonable time, detailed examination of the schools visited 
was not undertaken. In all, 19,9 schools, 138 rural and 61 urban, were 
thus inspected by the writer and a total of 859 schools in 9 States 
by all the service officers engaged in this work. It is very evident, 
as revealed by these inspections, that in the territory covered there is 
a general lack of sanitary supervision in the construction and mainte- 
nance of rural school buildings and of medical supervision of the 
pupils. 

* The prevention and correction of physical and mental disabilities 
that may embarrass a child in taking advantage of the education 
offered by the State is a prime duty of the State toward the child. 
It is this phase of the educational problem that lends so great impor- 
tance to school hygiene in general and to its application to rural 
communities in particular. According to the 1910 census report 
there were 10,529,871 pupils in attendance in rural schools and 
7,480,000 in the urban. Of these there were 793,710 more pupils from 
6 to 9 years of age, and 1,376,052 more from 10 to 14 years of age in 
rural school attendance than in urban. It is to be regretted that 
there is such a large proportion of children of impressionable age 
attending school without the advantages of sanitary and medical 
supervision. This is all the more regrettable because of the presence 
in rural communities of numerous children who are suffering from 
curable defects by reason of the want of skilled medical advice. 

DEFECTS REVEALED BY MEDICAL INSPECTION OF SCHOOLS. 

Mr. J. A. Pease, in a speech in committee of supply. House of Com- 
mons, thus summarizes the physical defects found among the school 
children of England : 

Impaired eyesi'ght, 10 per cent ; impaired hearing, 5 per cent ; ear disease, 3 
per cent ; adenoids, 5 per cent ; serious decay of teeth, 50 per cent ; tuberculosis, 

1 Reprint from the Public Health Reports, vol. 29, No. 37, Sept. 11, 1914. 
116162°— 19 3 



4 HYGIEN'E OF RUKAL SCHOOLS. 

2 per cent ; heart disease, 2 per cent ; malnutrition, 10 per cent ; mentally defec- 
tive, 1 per cent ; backward children, 12.5 per cent ; abnormally gifted children, 3 
per cent. 

These figures differ somewhat from those reported in various 
schools of the United States, but the relative proportions are about 
the same. The important point needing emphasis is that many of 
these defects, developmental and acquired, may be corrected in the 
early years of life, and to neglect them results in serious impairment 
of the health, growth, and efficiency of the child. 

Organized health work in schools until the present time has been 
largely confined to cities. Our investigations demonstrate the neces- 
sity of the extension of this work to country districts, where reside 
so large a number of people without the advantage of instruction 
relative to sanitary measures essential to health. In many districts 
the element of expense is a serious consideration, and it will be neces- 
sary to demonstrate the money value of school hygiene in the result- 
ing increased efficiency of the child and improved community sanita- 
tion. The general adoption of hygienic measures, however, will be 
gradual, and considerable time must elapse before any noticeable 
effect on community health will be observed except in restricted 
localities. The need for some properly constituted authority to make- 
intensive studies of rural school conditions in different sections of the 
country for educational value to the country at large is apparent. 

Our knowledge of the principles of school hygiene is far in advance 
of the actual practice. State boards of health and education may 
adopt rules and regulations in relation to the construction of school 
buildings, but their acceptance by communities poorly provided 
with funds, indifferently supplied with medical services, and entirely 
without trained sanitary advisers, is another question. It is neces- 
sary to educate rural communities in these matters. There is need 
for studies of rural schools from the standpoint of the child engaged 
in an occupation which in most States is a compulsory one. 

EXISTING NEEDS. 

One of the gravest situations observed in connection with schools 
of remote districts was the small attendance, though the child popu- 
lation of these districts was relatively large. Due attention to the 
construction, equipment, and maintenance of school buildings with 
respect to location, playground facilities, a proper regard for heating, 
lighting, ventilating, and seating equipment and sanitary toilet con- 
veniences will result in lessening juvenile delinquency and improv- 
ing the health of the community. 

The conviction arises from the investigation of trachoma in a 
number of heavily infected remote districts that this eye affection 



Public Health Reports. Reprint No. 219. 




FIG. 1.— SCHOOL WITH INSUFFICIENT WINDOWS. 

The windows are not large enough to provide sufficient light. They should be higher and the 

window panes larger. 




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FIG. 2.— A DANGEROUS SCHOOL PRIVY. 
Cover to seat of privy and door to entrance are lacking, thus allowing access to flies and aninnals. 
Excreta are deposited upon the ground, thus bringing about soil pollution. Thirty-eight out 
of forty children in this school were found to be infected with hool<wornn. The percentage of 
hookwornn infection in the county in which this school is located was 82.6. 



HYGIENE OF RUKAL SCHOOLS. 5 

can be controlled therein only by education, yet these are the dis- 
tricts where the observance of sanitation in connection with school 
life is least evident, and the necessity therefor the most apparent. 

The economic loss to communities suffering from this communi- 
cable disease of the eyes is very great through diminished earning 
capacity of those attacked. The value of improved sanitation and 
increased educational facilities to these infected communities can not 
be measured in dollars and cents, but the necessity therefor was 
revealed by the investigations just completed. 

The educational facilities provided by a community for its children 
is a reliable index of the culture and prosperity of that community. 
The sanitary provisions for schools is likewise a fairly accurate meas- 
ure of community knowledge of sanitary matters. Our investiga- 
tions have revealed a widespread need for instruction in rural sanita- 
tion, which can be given in large measure through rural schools. 
Certainly no better means can be devised for determining the endem- 
icity of certain communicable diseases, for tracing and controlling 
foci of tuberculosis, for the control of the so-called contagious dis- 
eases of childhood, and for the eradication of smallpox in rural dis- 
tricts than a general and properly conducted medical supervision of 
the schools. For example, in the course of these investigations the 
writer found over 10 per cent of the pupils suffering from trachoma 
in 21 rural schools, and over 20 per cent in 11 schools. In 4 schools 
the rate of trachoma infection was 35.29, 43.20, 43.75, and 46.15 per 
cent, respectively. 

The adult population represented by these school children is fixed 
in the habits and mode of life so largely responsible for heavy com- 
munity infection. The neglect of sanitary precautions will favor the 
continued spread of this disease, and the only hope for complete 
eradication lies in the education of the rising generations. It is along 
such lines that the greatest benefit is to be derived from the sanitary 
supervision and medical inspection of the schools of rural districts. 

Furthermore, in the course of these field investigations, the writer 
failed to find a single sanitary privy installed for the use of rural- 
school children. In numerous instances no privy accommodations 
whatsoever were provided, and soil pollution in the neighborhood of 
the schoolhouse was evident. In one county, 11 cases of typhoid 
fever with 2 deaths were traced to the infected wells of two schools 
during the year preceding these investigations. 

It is unfortunate that the school year in rural districts seldom 
exceeds six months. In many communities it is even less. Any 
loss of time in school attendance to a child of such limited oppor- 
tunity for education is a serious matter, and is the more regrettable 
because absences due to sickness are largely preventable. For 



6 hygie:n'e of eueal schools. 

example, Mr. A. Hughart, superintendent of the Valparaiso, Ind., 
public schools, had a record kftpt of the total time lost by all pupils 
on account of sickness and tardiness during the year 1910-11. 

The total enrollment of these schools was 1,000 pupils. The total 
loss of time of pupils from school during the year amounted in the 
aggregate to 37 school years. Seventy-six per cent of this loss of 
time was due to sickness, 60 per cent of it being occasioned by 
preventable diseases. The time lost on account of scarlet fever 
was 8^ years; from chicken pox 3 years 4 months and 13 days; 
toothache, 5 months. The loss to the community, therefore, on 
account of absences from school amounted to $1,850 — ^that is, 37 
years at $50 per year, the per capita cost. The loss due to pre- 
ventable diseases was $1,100. The neglect of sanitary supervision 
of schools, therefore, results not only in injury to the child through 
inability to take advantage of the opportunity for intellectual train- 
ing, but also in actual calculable monetary loss to a community, in 
many instances, poorly supplied with funds for educational purposes. 

The sanitary needs revealed by these surveys are many. In gen- 
eral, they are due to lack of skilled advice, and are those of location, 
construction, and equipment as applied to school buildings. The 
accompanying cuts are typical of existing conditions in many places, 
as will be recognized by those familiar with rural schools. 

With respect to the child, rural education is a practical illustration 
of the survival of the fittest. There is no uniform medical supervi- 
sion of rural-school children, and in many sections only an indifferent 
adaptation of intellectual training to the physical and mental ne- 
cessities of the child. That men come from the countr}^ and in the 
course of time, in spite of the disadvantages of early training, take 
prominent places in medicine, law, theology, and finance in urban 
communities is further evidence of the desirability of extending to 
such people all the benefits of education and hygiene. 

These rural communities are also denied the benefits to be derived 
indirectly from the application of the principles of hygiene to schools 
and school life. "With the extention of the movement to consolidate 
several schools into one the school year will be lengthened, better 
schools will be provided, medical inspections become possible, the 
district school nurse will evolve, sick children will be visited, and the 
principles of correct sanitary living will be taught in the homes. 
The benefits to be derived from such measures are obvious, but not 
fully appreciated even in communities where they are in force. It 
can not be expected, therefore, that these conditions are to be brought 
about at once. There is necessity for much painstaking effort and 
actual demonstration before these measures, no matter how urgently 
needed, can obtain in many sections of our country. 



HYGIENE or RURAL SCHOOLS. 7 

Lastly, the study of the sanitary condition of the schools and the 
medical supervision of the pupils in rural districts will be of the 
greatest value to the State at large and the State board of health in 
particular, because such studies bring to light most clearly the public 
health needs of such communities. 

Furthermore, where full-time health officers are not available 
because of lack of funds, the rational combination of their duties 
with those of the medical supervision of schools would make the 
employment of such an officer practicable and profitable. 



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